| NPI | 1457501876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: AZ 3913) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: AZ BA15) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: AZ 3913) | |
| Enumeration Date | 2008-09-22 |
| Last Update Date | 2020-03-05 |